Anatomy Based Fitting works best with deep electrode insertions

[Mary Beth]

One of the reasons I may not benefit from anatomy based fitting MAPs is that my electrode insertion depths do not meet the recommended depths to benefit best from ABF.  I know both my right and left depths are less than the recommended 630 degrees for ABF.

This is what Med-El states as being best matched to anatomy based fitting

@Tim

[Mary Beth]

An interesting thing about this is the average angular insertion depth of various Med-El electrode arrays shows that only the longest electrode arrays (standard/flex soft) tend to meet the recommended insertion depth to benefit most from anatomy based fitting

@Tim that’s your array right?

 

https://www.sciencedirect.com/science/article/pii/S0378595517302940

[Ricky W]

During surgery if you have full insertion up to the stiffening ring does that mean the electrode is inserted to the end of the cochlear?

[Tim]

@Mary Beth Thanks for the info. Yes  - that is my electrode array!  They said I had a good, full-insertion of the 31.5 mm electrode.

My next map was rescheduled to tomorrow morning so I'll ask about that again.

Since I had surgery this year, blew past insurance deductibles for the year so if they will cover the CT, that would be good.

Tim

 

[Mary Beth]

@Ricky W

No.  Med-El offers a wide range of electrode lengths and types to best fit various cochleas.  I have full insertion but do not have a 630 degree insertion depth because the best electrode for my complicated right cochlea is shorter than the standard/flex soft electrode.

[Ricky W]

Without having the full insertion can you tell a difference in low frequencies the way for example a dog bark does it sound natural to you. 

 

[Mary Beth]

@Ricky W

My electrode array is fully inserted, it is just a shorter stiffer electrode design.

I have excellent bass tones.  
 

I can distinguish the difference between trombone and bass trombone.  Hear and enjoy deep bass male voices and deep tones in music.

It is an amazing CI ear.  I feel very fortunate.

[Ricky W]

Since I have 2 Med-el implants music sounds better to me know more than it did when I had normal hearing. To me it's like sitting in front of the instrument....pianos sounds amazing.

[Tim]

@Mary Beth At today's MAP session, I mentioned having another vertigo episode last night that didn't fit the pattern for normal BPPV.  My word recognition scores are getting better but not as fast as my Audi hoped for given all the work that I was putting into rehab.  She there were a few electrodes that were operating well but didn't seem to be giving the benefit that she hoped. 

The result is that she thinks a CT is justifiable and is going to talk with the surgeon about recommending it.  Fingers crossed for insurance to approve.

She said that she went to a recent conference and kept hearing about ABF over and over again about the success patients had been having.  She is hoping to get that to be a standard practice at the clinic for Med-El patients.

Hoping to join the ABF club soon and get insight about the vertigo. 

 

[Mary Beth]

@Tim

sorry to hear of your vertigo issues.  I hope that gets resolved soon.

Keep us updated.

Med-El presented on ABF at the American Cochlear Implant Alliance conference held last month.

[Tim]

@Mary Beth @Lauren @Caroline

I just got back from Anatomy Based Fitting, ABF, appointment.  I'll share my experiences here in case it helps others.  Sorry for the length but maybe different people might find different aspects interesting or useful.  Feel free to ignore or brew a big pot of coffee!

Lauren gave me a headsup that her clinic had a very hard time getting the files to Med-El for the ABF.  It seems to be harder than simply sending the CT for Otoplan.  Perhaps it is a different version of the file. Med-El seems to have a good process for it but clinics/labs are still figuring out how to incorporate the workflow.  I had the CT done 9 days ago, surgeon's review of the CT about 7 days ago, but even yesterday my 48 hours before the ABF appointment, my Audi was concerned that the file might not be able to sent in time for Med-El to review.  Everything came together in the end but just barely.  Lesson:  Budget a lot of time between post-op CT and ABF appointment.

Med-El seems willing to have reps in attendance for the ABF appointments if Audis request it.  I'm only the second ABF for my Audi and she was glad to have the rep attend. Lesson:  ABF is new for many Audis - can be a good excuse to meet a Rep.

At the end of the appointment, my Audi needed to move on to the next person but she knew that the Rep and I would have a lot to talk about and gave her a heads up - "he's an engineer..."  My Audi found an unused office where the Rep and I could talk for about two more hours.  Lots of topics that she wanted feedback on, talk about in-person social get togethers returning like pre-covid days, rehab ideas, Lauren's Alaskan earthquakes, the Rondo cradle,  and more.  My wife finally texted worried that something had gone wrong that it was taking so long!  Lesson:  Take the opportunity to talk with the rep if you can.

We are on ABF software 1.0, my rep said that more advanced versions of the software are already in testing and would not require updated CTs beyond the first CT for ABF.  It might be able to leverage untapped capabilities of the Med-El electrodes.  Lesson:  The benefits of ABF may grow over time but the same image is used so don't wait.

My ABF was a little surprising.  It seems like often they are able to fit the lower frequency electrode (#1) to an even lower frequency range than the default for that electrode.  In my case the lowest frequency was bumped a little higher. 

The more surprising movement occurred at the high frequency range.  We spent most of our ABF time experimenting with the high frequency range.  My electrode #12 by ABF placement maps to about 13.5KHz.  This is well above the maximum frequency range supported by Med-El processors of 8.5KHz.  If they limited to just tonotopically matched and supported electrodes, they could disable both #11 and #12.  On the other hand, that is losing a lot of potential "signal opportunity."

We disabled #12 and adjusted other electrodes accordingly as a test.  The "s" sound was really problematic.  After some various testings, we decided to keep all 12 electrodes active.  This means that it is not a pure ABF and more of a "hybrid ABF" since the upper frequencies are not distributed based on the anatomical location but instead based as much signalling opportunities.  (This hybrid term is not an "official description" but is my interpretation.  I could be wrong!)  Lesson:  Be sure to test and experiment with the ABF MAP before leaving. 

Next decision was should the map be put on just some of the program slots or on all program slots.  I said that I already have purposes (use cases) for all of my 4 program slots on both processors.  I don't want to lose one as a "test program".  Besides, I did that with trying the FS4-p stimulation with only some program slots.  Not worth the hassle.  I said let's just jump in with both feet.  The changes are noticeable and might feel like a small half step backward initially if a lot of work has been put into rehab already with the likely big step forward after putting in some rehab effort to help get the brain to adjust to changed frequencies.

We've got a followup scheduled in a month to assess how the ABF is working.  Lesson: If the ABF doesn't have huge changes, jump in with both feet and change all the programs.  You can always change it back later.  

Okay, so how does it sound after ABF.  At the appointment it sounded fine.  I couldn't tell any significant difference between the ABF and pre-ABF map.  Not a big enough difference to be clearly apparent other than the "bad" change of turning off an electrode and losing the "s" sound. 

I'm now 6.5 months post activation.  In terms of sound quality - it feels like I might have gone back in time a couple of months.  This is only a couple of hours after the ABF appointment.  I'm streaming my spotify playlist of "liked" music.  Lyrics are a little off and less clear than before the ABF. 

We didn't have time for a booth test today but I expect that the word recognition scores would also have regressed some. I switched from Spotify to an Audiobook that I've been listening to.  The words are definitely less clear and require more attention.

All of my experience seems consistent with minor frequency realignment for the ABF.  Brain just needs to be given a little time to change its expectations.  Lesson:  Temper expectations, it might take a little time for adaption.

Hope this all helps.  I know others have experience with ABF also, feel free to chime in, clarify, correct, etc.

My Audi and the Med-El provided me with a lot of data on frequencies for each electrode (pre-ABF, ABF, and the hybrid actually used.)  I may try to make sense of organize it to post in here as well but didn't want to delay posting the more text-oriented description of the experience here. Let me know if that would be interesting or helpful. 

In summary, ABF looks like it will become the standard practice to get ABF for Med-El implantees at my clinic in the future.  It seems like the earlier the ABF is done, the less adjustment might be needed for maximizing benefit.

Again, thanks everyone for the encouragement of lobbying for ABF. 

 

[Enegra]

Thank you for the detailed post with your experiences, @Tim. The novelty of the software and lack of experience could explain why my hospital, which is supposedly the best one in Finland when it comes to implants, is not very eager to use it. I haven't gotten to speak with a programming person yet, but the surgeon's opinion is that they would consider ABF as a backup if the default frequency allocation is not providing me good results.

[Tim]

@Enegra I tried lobbying My Audi and Surgeon for ABF at the very beginning and they declined saying that insurance would reject it as not medically necessary. They said the case might be stronger later if I was having difficulty.  Seems similar to the answer that you got. 

Of course if anyone has a case for not having satisfactory progress - it should be you!  In the US I think the hospital would be very scared about a medical malpractice lawsuit and eager to give you anything you wanted.

6 months later, my Audi was willing to go to bat for me to try to get ABF for several reasons:

• She was at the conference that Mary Beth mentioned and felt that she was being bombarded with positive ABF experiences in session after session.
• My word recognition scores were improving but not at the rate that she expected given my hard word in rehab.
• She was glad to have another guinea pig for learning about ABF.
• I said that I had already paid my annual deductible with the CI surgery so it would be worth it to get the CT scan this year instead of next year.
• Some odd anomalies of changing electrode impedances. 
• 3 episodes of vertigo but which didn't seem to match classic BPPV.

The last two items are not directly addressable by ABF but perhaps another CT would help uncover root causes. The anomalous impedance seems to have resolved by today's appointment.  The surgeon's notes didn't see anything explaining the vertigo either but I was happy if it helped getting insurance to say yes.

 

[Enegra]

@Tim The US is known on the other side of the pond for its tendency for litigation. In Finland it's actually difficult to get the hospital in trouble, one would have to prove wilful neglect or other deliberate action rather than just a series of wrong decisions that would've been fine in "standard cases". I happen to have some anatomy quirks that are not something that would show up easily in MRI/CT scans and which the hospital has been unaware of. So, thus far they still haven't been feeling sorry enough to grant me individualised treatment.

I actually have a pending case for their inactivity last year, which ended up resulting in explantation and my right ear quite butchered, but the average processing time is 11 month for these complaints. They started processing mine this spring, so who knows how long it takes due to the length and complexity of the issue. The ombudsman had to submit it manually, because the default form did not offer enough space for describing the events, even when only giving a brief version and only listing the most important points...

[Lauren]

@Tim thank you for that detailed report! Glad it all worked out in the end. 

My brain got scrambled too. I briefly lost the ability to understand phone calls and certain people at work but with perseverance and practice it’s come back as my brain unscrambled itself. Whatever scrambling happened, if any, will work itself out with practice and time   

Have to admit, I’m jealous you got to spend so much time with the rep. I normally only get my appointment time then they either have other patients to see or other things to do. They usually just fly up in the morning and then return to Seattle that afternoon. A real whirlwind trip. “They” because sometimes I get a pair. My second ABF appointment I had Sarah and a surgical specialist. 

 

[Tim]

(This is a replacement post for one posted in the wrong thread-sorry about that, it has been a busy day.)

Here are the frequencies that I had from my ABF appointment.

	ABF Estimate			Original Frequency Allocation				Used "Hybrid" Fitting
Electrode	Angle (deg)	OC (mm)	OC (Hz)	Lower	Center	Upper	Band- width	Lower	Center	Upper	Band- width
1	639.0	32.2	175.0	70	120	170	100	70	142	214	144
2	576.2	30.1	274.9	170	235	300	130	214	305	396	182
3	500.0	27.6	436.3	300	385	469	169	396	514	633	237
4	406.0	24.4	730.6	469	580	690	221	633	790	946	313
5	317.2	21.0	1225.6	690	836	982	292	946	1193	1440	494
6	268.2	18.7	1691.0	982	1175	1368	386	1440	1720	2000	560
7	218.5	16.3	2365.6	1368	1624	1881	513	2000	2385	2770	770
8	172.3	14.0	3244.5	1881	2222	2564	683	2770	3118	3467	697
9	129.0	11.6	4466.8	2564	3020	3475	911	3467	3902	4338	871
10	94.2	9.5	5914.2	3475	4084	4693	1218	4338	4823	5428	1090
11	53.0	6.7	8552.2	4693	5507	6321	1628	5429	6110	6793	1364
12	14.1	3.7	12727.6	6321	7410	8500	2179	6793	7646	8500	1707

 

I'm going to try to interpret things as I understand them but please chime in if I'm misstating anything. I turned gray things that may not be as important for general understanding.

The ABF estimate is based on the reading of the CT indicating the angular position in the cochlea, the position by distance and perhaps most importantly, the interpretation of the frequency that this electrode is placed at. For electrode 1, this means it is at 639.0 degrees, 32.2 mm of depth?, and that placement is at 175 Hz.

The next four columns are for my original frequency allocation with my Flexsoft 31mm electrode.  This would be what I had from Activation to today. They have an assumed set of frequencies at activation.  Therefore electrode #1 is centered on 120 Hz but covers the range from 70 to 170 Hz. This electrode is then covering a range of 100 Hz. If I'm understanding things correctly, everyone with a 31mm Flexsoft programming would default to these values. 

The last four columns are for the "Hybrid" fitting that we selected for actual usage for me. 

A few interesting observations.  The hybrid fitting  for the first electrode was found to be sitting at a higher frequency position in the cochlea (not as deep into the cochlea) so it is centered on 142 Hz instead of 120 Hz.  That electrode will still signal information for me down to 70 Hz though.

The high frequency electrodes #11 and #12  are even ore interesting.  They are position so close to the beginning of the cochlea, that their frequencies are above the frequency range supported by the processor (8552 Hz and 12,727 Hz respectively.  They are remapped to max out at 8500 Hz since the CI can't send anything at a higher frequency.  

I'll be curious to see how things change doing more rehab over the weekend. I'll periodically post updates on how the adjust to ABF is going in this thread.

Again, thanks to Med-El for doing this quickly and the great support. 

 

[Tim]

@Lauren Using the ABF for the day, I agree with your characterization of it being "scrambled."

It sounds fine in everyday use.  I only really notice the half step back when streaming to the CI. Liked and frequently streamed music all sound worse right.  Streamed voices sound distorted and I can see why. 

Given that electrodes 1 and 12 have pinned lower and upper limits respectively, it seems like the other 10 electrodes might give give a better perspective of the relative change.

Across electrodes 2-11, the "center frequency" of each electrode was bumped up by an average of 519 Hz.  The proportional change might be more meaningful and it was an average frequency shift of +33.4% across each of those 10 electrodes. 

This also means that the lower frequency electrodes are needing to cover wider bandwidths than in the past suggesting that lower frequency phonemes might be harder to differentiate. Conversely, higher frequency electrodes are covering smaller bandwidths than before so it might help with higher frequency phones, women's voices, and higher pitched musical instruments. 

Definitely need to roll up the sleeves and invest effort in rehab after ABF. 

I have an ABF followup appointment a month from now before the start of the school year.  Should have a good perspective by then.

Does anyone else here know how much ABF shifted their frequencies?  I'm curious if that 33.4% shift is common or bigger than others.  (Some people might even go the same % in the opposite direction!)

 

 

[Mary Beth]

It’s all very interesting.  Med-El says the flex soft electrode can achieve an angular insertion depth of 720 degrees.  It seems like your angular insertion depth is  639 degrees @Tim.  Possibly this explains why electrode 1 is not positioned as deeply for the bass tones so there is a recommended upshift in ABF.  And also why electrodes 11 & 12 are not as far in so are positioned where frequencies that are higher than the system can deliver.

This must vary with each ear even when using the same electrode (flex soft) in ears with the same cochlear length.

 

I have been eagerly searching for studies on using ABF in people who have already acclimated to their CIs.  So far there is not much information out there about how established CI users respond to ABF MAPs.  @MED-EL Moderator do you have links to any studies on using ABF with already established CI users?

 

People who get activated using ABF MAPs, learn to listen with their CI and will require no additional acclimation than any CI user after activation.

[Lauren]

I only have a visual representation of my left side pre- and post- ABF and I can’t figure out how to share it privately in the forum’s email system. My audiologist didn’t know how to provide me with a printout at my first ABF appointment and I forgot to ask again at my second. I’ll try again at my appointment next week. A lot of my requests, including ABF, have been totally new for my area so just bearing with my audiologist clinic as they learn these cool new things. 

[Tim]

@Lauren My Audiologist had to use screen captures to get some of the information and Sarah brought in an ABF  with nice formatting  and a Med-El logo for ABF information.  My Audi warned her that I would like details and technical information.  As for sharing private information, you could tape over any personally identifiable information.  I'm not worried about sharing frequencies, angles of insertion, or other issue personally and thought it might be helpful for others in decoding their own information.

@Mary Beth Sarah said my cochlear duct length was a little over 34.0 mm.  I meant to ask whether that meant if I could have fit the 34 mm electrode but too much was going on and forgot to ask.  (The 34 mm electrode wasn't announced at the time of surgery and still isn't available it seems in the US.)  Maybe the longer length electrode would have helped for more low frequency.  Then again, might not have been good to be pushing my luck for getting a good insertion.  Residual hearing was blown away (all frequencies are over 100 dB of attenuation.) 

Thanks for asking the moderator about research studies.  Sarah said that there will be papers coming out soon.  I'll be interested in seeing research on ABF on people that are well acclimated - not sure if you could me as "acclimated" after six months.

Would have been really nice to get the ABF earlier since I feel like it might take me a couple of weeks or a month to get back to where I was pre-ABF. I think it might be easier/faster than original rehab since the brain is tuned to listening to those regions of stimulation, just needs to think of it as a different frequency.  Perhaps a bit like people sounding funny when you have a head cold. 

I still think it was a good thing to do and my thought is a half step back to take several steps forward in the future.

For those that are not yet acclimated to another map, it seems like a great idea and may give a half step faster start on rehab.  Definitely seems worth lobbying for before initial activation.

For those thinking of doing ABF after being acclimated, I would pick a time when you know that you can tolerate some possible degradation of hearing for a few weeks.  For example, a student or teacher might want to aim for doing it at the beginning of winter or summer breaks.  Of course this is just anecdotal and looking forward to seeing real research.

 

 

[Tim]

As promised, here is a first update:

I had my ABF done on Friday. Like @Lauren said, it does not feel like fully starting over in rehab but it is a bigger step back than I had expected before ABF or appreciated before leaving the office. As with even the CI to start with, it is important to come in with realistic expectations, patience, and perhaps a sense of humor.

After three or four days, it underscores that it really will require some work. I decided to jump in fully with no backup of the old frequency allocation to fall back on. 

With SSD, I feel that I can still function and my good ear is doing a lot of work.  I really only notice the step back in rehab when I try to stream directly to the CI. General everyday activities are not impeded, I just notice an occasional minor distortion on a sound.  If were relying only on the CI, it would be much more critical. 

I had my activation at the end of January so about 6.5 months ago. We didn't have time to do a booth test of where I am after ABF.  Instead I'll give my qualitative assessment of where in my 6.5 months of rehab it feels like I am in the journey. 

Audiobooks: I've done a dozen audiobooks via direct CI streaming but can't do an audiobook right now. Feels like being back at 1.5 to 2 months post activation.

Podcasts:  A podcast that I've listened to for months with the same speakers and was doing at an accelerated speed is now only 50% intelligible.  Feels like being back at ~2 months post activation.

Music:  My favorites list is more muddled.  Feels like being back at 2 or 3 months post activation.

WordSuccess (Rehab App): I went back to the beginning. Feels like being back at 2 months post activation.

Hearoes (Rehab App):  Word challenges are harder but have gone back to environmental sounds and it seems like I might be hearing more richness in some of the sounds.  (Maybe it is also because I had not done much environmental sounds for a couple of months.) Maybe feels like less of step back like being at month 4 or 5. 

BendMyEar (Rehab App):  Sentences are harder and require more attention than before ABF. I have a harder time placing it relative to my timeline of recovery.

One thing that I had not anticipated was that my wife got used to me feeling like things got better at every MAP session and she was really surprised that it was instead a (big?) step back.  I should have prepped her better in terms of expectations management.

I have an appointment with my audiologist in a month. I hope that I will be caught up by that point and get a booth test.

Some comments or ideas:

• Wondering if as long as I was willing to take a step back on the frequency map, maybe I should have gone all the way and done FS4-p stimulation too.  (I tried it as an alternative program but only gave it a week of usage before giving up on that.  More discussion of FS4-p here.) 
• The ABF might be more impactful for people with Sonnet EAS and retained residual hearing since the EAS would be trying to rely on those same frequencies.  Reducing tonotopic frequency mismatch between residual hearing and the electrode would seem difficult. I don't have any useful residual hearing after implantation so a non-issue for me.
• The general upwards shift  of frequencies for me (others may be different) might be a nice benefit of differentiating some of the higher frequency sounds. As mentioned above, I heard things in Hearoes' environmental sounds that I don't remember ever picking up on before.  Maybe the benefits accrue earlier for environmental sounds than words. 
• Getting the ABF at the beginning is much better than waiting months down the road.
• I'm glad that I don't have critical high fidelity work/social events in the next month and can relax with doing rehab.

All in all, I am still glad that I did the ABF - just wish that I had been able to do it much earlier (ideally at activation.)

Every day is a chance to continue down the rehab path.

I'll give an update on Sunday at Mary Beth's Google Meet.

 

[Lauren]

@Tim Interesting!

I had my ABF done about 7.5 (ish) months in, keeping in mind my left ear had to start again from scratch so really only had “7.5 months” as well.

Initially ABF didn’t seem like too big a shift but as my first one was only the right side I lost a LOT of comprehension. After getting the left side up and running it went much better. Now almost 2 months in, my first booth test is on Friday plus some minor adjustments I want to make. Also just realized my right Rondo 3 (and only that processor) wasn’t programmed correctly in regards to the microphone. 

Hopefully the below isn’t too blurry but it’s the photo I’ve been trying to figure out how to share. It’s really the only information I have on any of my MAPs beyond the basics. Hoping to get more on Friday. Please note it’s only the initial change from my first ABF so it’s just the right side.  

Anyways just give your brain time to work out the new MAP. About one month was how long my poor scrambled brain needed. 

[Serena Metzler]

40 minutes ago, Lauren said:

@Tim Interesting!

I had my ABF done about 7.5 (ish) months in, keeping in mind my left ear had to start again from scratch so really only had “7.5 months” as well.

Initially ABF didn’t seem like too big a shift but as my first one was only the right side I lost a LOT of comprehension. After getting the left side up and running it went much better. Now almost 2 months in, my first booth test is on Friday plus some minor adjustments I want to make. Also just realized my right Rondo 3 (and only that processor) wasn’t programmed correctly in regards to the microphone. 

Hopefully the below isn’t too blurry but it’s the photo I’ve been trying to figure out how to share. It’s really the only information I have on any of my MAPs beyond the basics. Hoping to get more on Friday. Please note it’s only the initial change from my first ABF so it’s just the right side.  

Anyways just give your brain time to work out the new MAP. About one month was how long my poor scrambled brain needed. 

Congratulations 👏😎😎😎😎😎😎

[Tim]

@Lauren Thanks for sharing the printout.  A little blurry but I think that I can make it out.  Not an expert by any means but this is my ballpark guess on interpretation. The chart shows the ABF placement and the currently selected frequencies after ABF I think.  (I'm assuming the chart at the bottom is what you have after ABF but it is possible it was your pre-ABF distribution.)  It seems like MED-EL probably has a default distribution for each electrode length.

Happy to have others clarify or correct! 

Looks like your ABF frequency distribution (dark circles on the chart) has some similarities to mine.  It says the shallowest electrode #12 is positioned at a higher frequency than the processor supports (~12000 Hz, well past the 8500 Hz) like mine.  Electrodes  #12  and #11 are then mapped to lower frequencies like mine rather than disabling electrode #12.  Same choice I made to keep the electrodes and I'll let the brain remap that.

Your deepest electrode, #1, is positioned at about 350 or 400 Hz, mine was at 175 Hz. It seems like this is suggesting that it didn't go as deeply. Rather than trying to cover such a broad range frequencies (say 70 to over 400 Hz), it seems like they set the center frequency to be 161 Hz.  In my case, it was set to 142 Hz.

Perhaps ABF would be even better with the longer electrodes and getting that last electrode (most shallow, #1), pushed a little deeper. 

Did you get an Otoplan to select the electrode?  I had a 31 mm and maybe could have used the forthcoming 34 mm  which might have allowed a better match to the low frequencies.  If they did an Otoplan, did they say your cochlear duct length? 

Based on both yours and mine, it looks like ABF is used as a starting point for frequency mapping rather than letting it dictate decisions like disabling electrodes that are outside of the processor supported ranges.  Seems good.

I liked your characterization of "scrambled brain" - I agree. Probably a similar time as you since we had similar amounts of time to get acclimated to the original frequency distribution and had to "unlearn".  I'm hoping for that same one month timeline to get unscrambled before Fall classes start. 

Perhaps others @Heather W that have had ABF as a part of the research projects can dig up information. 

 

[Lauren]

@Tim no, I did not get Otoplan. My surgeon just had multiple electrodes available and I think I have Flex 28 in both cochlea. There was surgical specialists from Med-El present though, both times. One of the specialists from my second surgery was present at my ABF map. So I don’t have any doubt they did the best possible job they could. The surgeon did seem pleased with the outcome both times.

I’m hoping to get more information at my appointment Friday and might confer with Sarah via email as well.